78 THE DISEASES OF THE THYROID GLAND 



exchange is mostly answered that the increase of the protein of exchange 

 is primary. Fritz Voit found in dogs after feeding with thyroid-gland sub- 

 stance a negative nitrogen equilibrium even when the diet contained abun- 

 dant-fat, so that fat could even be deposited [in the body]. This experiment 

 does not seem conclusive as the nitrogen-free energy in the diet was exclu- 

 sively upheld by fat. The same objection may however be made against the 

 statement of Magnus-Levy that on the administration of fat or on abundant 

 fat deposition, the loss of nitrogen is indeed appreciably restricted, but not 

 entirely done away with. In the experiment of Rudinger the elimination 

 of nitrogen could be depressed to the Lander green's minimal quantity, if 

 larger quantities of nitrogen-free energy (with abundant carbohydrates) 

 were ingested for a long time. We can therefore conclude that in hyper- 

 thyroidism there exists only a heightening of. the physiological relations. 

 This is indeed true for the lighter grades, but in the higher grades the de- 

 generative changes of the muscular substances such as are described by 

 Askanzy, speak for a toxic disturbance. 



Jaquet and Svenson state that in the Basedow's patients the exchange 

 after ingestion of food is raised higher than in normal individuals. In the 

 investigations of Forges and Pribram the fundamental exchange after transi- 

 tory copious administration of protein was found to be abnormally high. It 

 therefore seems as though the metabolism of Basedow's patients were espe- 

 cially labile, the administration of protein perhaps increasing the activity 

 of the thyroid gland in an especial manner. For this perhaps speaks also 

 the fact that we can make the thyroid of dogs extremely poor in iodine by 

 abundant administration of meat, this pointing to a rapidly leading off of 

 the specific secretion; also, as is known, the Basedow struma is characterized 

 by its very slight iodine contents. 



The disturbances of carbohydrate metabolism in Basedow's disease do not 

 seem to be of a uniform nature. There exists a combination of hyper- 

 thyroidism with true diabetes (v. Noorden, Ewald, Grawitz, Hannemann, 

 Bettmann, Falta, and others). This diabetes shows only a slight dependence 

 on the course of the hyperthyroidism. In the cases I described, X-ray irra- 

 diation had only a slight influence on the elimination of the sugar. With this 

 agrees the fact that in true diabetes mellitus we can influence the sugar 

 elimination by administration of thyroid gland only in the aglycosuric con- 

 dition or on light glycosuria, while in the higher grades of glycosuria the 

 influence is not so prominent. Also in the dog after complete extirpation 

 of the pancreas, under the administration of thyroid-gland tablets there was 

 no appreciable increase of the D : N quotient. In my cases of diabetes and 

 Basedow's there were profuse diarrheas, while cases of true thyrogenic 

 glycosuria, of which I shall speak presently, show disturbances of fat ab- 

 sorption following overloading with fat. 



The combination of Basedow's with true diabetes is not so very rare. 



